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General NPI Number Information
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NPI Number | 1215010467
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Entity Type | Organization
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Legal Business Name | CORSI HOEY PEARSON DDS INC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1350 MEDICAL CENTER DRIVE
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City | ROHNERT PARK
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State | CA
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Zip | 94928
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Country | US
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Telephone | 707-584-1630
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Fax | 707-584-2394
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Provider Business Mailing Address
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Address Line | 1350 MEDICAL CENTER DRIVE
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City | ROHNERT PARK
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State | CA
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Zip | 94928
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Country | US
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Telephone | 707-584-1630
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Fax | 707-584-2394
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. JON KENYON SCARR
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Credential | DDS
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Telephone | 707-584-1630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 25762
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License Number State | CA
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